不同手术方法治疗膀胱阴道瘘  

Comparison and discussion of different surgical methods used to treat vesicovaginal fistulas

作　　者：张维宇[1] 胡浩[1] 张晓鹏[1] 孙屹然[1] 王焕瑞 许克新[1] 

机构地区：[1]北京大学人民医院泌尿外科,北京100044

出　　处：《北京大学学报（医学版）》2017年第5期889-892,共4页Journal of Peking University:Health Sciences

摘　　要：目的:比较不同手术术式治疗膀胱阴道瘘的易行性及患者预后,评价电凝术用于小直径膀胱阴道瘘治疗的价值。方法:选择北京大学人民医院泌尿外科2008年10月至2016年11月收治并持续随访的膀胱阴道瘘患者资料进行回顾性分析,共计19例,患者年龄31~55岁,中位年龄48岁;病程1~24个月,中位病程3个月,比较不同手术术式用于膀胱阴道瘘治疗的瘘口情况和手术预后等是否存在差异。结果:3例行电凝术,4例经阴道修补,7例开放腹腔切开膀胱前壁进行修补,5例进行腹腔镜修补。除1例患者拒绝留置尿管和D-J管外,其余患者术后常规留置尿管与双侧D-J管。68.2%的病例(13例)手术成功,术后未再发生阴道漏液。63.2%的病例(12例)手术一次成功,术后平均1.5个月完全恢复。3例行电凝术修复的患者,1例重复手术2次,术后1个月恢复,另外2例均在术后1个月拔除尿管和D-J管后恢复;4例经阴道修补的患者,3例在术后1个月拔出尿管和D-J管后恢复,1例术后恢复差;7例开放手术的患者中,5例手术效果好,术后恢复佳,1例转外院继续治疗,1例于北京大学人民医院进行二次手术,预后仍差;5例腹腔镜修复的患者,3例一次手术成功,术后1个月拔管后痊愈,2例患者于外院进行二次手术,术后愈合差。电凝术用于治疗膀胱阴道瘘,手术简便易行,手术时间短,住院时间短,患者恢复佳。结论:电凝术创伤小,出血少,效果好;经阴道修补适合瘘口位置低,利于暴露手术视野的病例;开放手术、腹腔镜手术适合复杂性膀胱阴道瘘,尤其是需要同时处理输尿管开口狭窄、输尿管瘘等并发症的病例,但手术时间长、出血多、创伤大,不利于术后恢复。对于单一瘘口、瘘口直径小的膀胱阴道瘘推荐首选电凝术。Objective: To compare the feasibility and prognosis of different surgical methods used for vesicovaginal fistulas and to explore the value of electrocoagulation treating small ones. Methods: The medical data of 19 patients who had undertaken transvaginal VVF repairs in Peking University People's Hospital between October 2008 and November 2016 were retrospectively collected. The follow-ups were performed. The patients' age ranged from 31 to 55 years with the median age of 48 years and the history length ranged from 1 month to 24 months with the median length of 3 months. Their fistula situation,surgical methods and prognosis were analyzed and the differences and similarities were compared. Results:Three patients( 15. 79%) was performed by electrocoagulation,4( 21. 05%) by transvaginal repair,5( 21. 32%) by laparoscopic repair and 7( 36. 84%) by open operation. Except one patient who rejected urinary catheter and D-J catheters,the rest of the patients discharged with catheters. Twelve patients( 63. 2%) got full satisfaction with one operation. One of the 3 patients who undertook electrocoagulation repeated the operation for twice and got completely cured within 1 month while the other two undertook the operation once and got dry within 1 month. Three patients who undertook transvaginal repair got dry within 1 month. Two of the 5 patients who undertook laparoscopic repair had readmission for a second operation and the other 3 got dry after operation. Five of the 7 open repair patients got dry while the other2 attempted other center for treatment. Conclusion: Transvaginal repair has been the main surgery procedure for VVF,but it is limited by the location of fistula and the condition of vaginal. For patients not suitable for transvaginal repair,laparoscopic repair and open surgery are feasible. However both laparoscopic repair and open surgery are more invasive. Based on that,electrocoagulation becomes a better choice. In our research,patients with small and high location fistula treated by electrocoagulation got a h

关 键 词：膀胱阴道瘘 治疗 修补 手术术式 电凝术 

分 类 号：R694.13[医药卫生—泌尿科学]